Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Key Points Acute graft-versus-host disease (GVHD) of the gastrointestinal tract is a common complication in patients after haematopoietic stem cell transplantation (HSCT) that results in considerable morbidity and mortality As the clinical, serological and radiographical findings in gastrointestinal acute GVHD are nonspecific, a broad differential diagnosis should be considered, particularly potential infectious causes and chemotherapeutic or immunosuppressant toxicity Expedient endoscopy and histopathology are helpful in excluding possible conditions that mimic gastrointestinal acute GVHD; nevertheless, the diagnosis is ultimately based on clinical criteria Several novel diagnostic, prognostic, risk and predictive biomarkers have been identified for gastrointestinal acute GVHD; however, none have yet been integrated into routine clinical practice Upon diagnosis of gastrointestinal acute GVHD, timely first-line therapy with systemic corticosteroids (such as prednisone or methylprednisolone) and/or oral non-absorbable corticosteroids (such as beclomethasone or budesonide) is crucial Acute GVHD leads to substantial gastrointestinal symptom burden, including profuse diarrhoea, abdominal pain, severe malnutrition and gastrointestinal bleeding; providing supportive and palliative care is a critical role of the gastroenterologist Following haematopoietic stem cell transplantation for the treatment of haematopoietic diseases, acute graft-versus-host disease (GVHD) of the gastrointestinal tract is a common complication that presents distinct diagnostic and therapeutic challenges. In this Review, the authors tailor their discussion of the diagnosis, staging and clinical management of gastrointestinal acute GVHD for practising gastroenterologists. Haematopoietic stem cell transplantation (HSCT) is central to the management of many haematological disorders. A frequent complication of HSCT is acute graft-versus-host disease (GVHD), a condition in which immune cells from the donor attack healthy recipient tissues. The gastrointestinal system is among the most common sites affected by acute GVHD, and severe manifestations of acute GVHD of the gut portends a poor prognosis in patients after HSCT. Acute GVHD of the gastrointestinal tract presents both diagnostic and therapeutic challenges. Although the clinical manifestations are nonspecific and overlap with those of infection and drug toxicity, diagnosis is ultimately based on clinical criteria. As reliable serum biomark